Prophylaxis of hemicrania continua: three cases effectively treated with acemethacin.

Hemicrania continua is a daily headache disorder that is characterized by unilateral, constant pain with exacerbations of intensity accompanied by autonomic symptoms. Response to indomethacin is the diagnostic criterion for hemicrania continua, but efficacy of indomethacin in therapy is restricted because of gastrointestinal adverse events. Therefore, many patients are disqualified from treatment with indomethacin, creating a need to search for alternative therapy. In comparison with indomethacin, acemethacin seems to have a better therapeutic profile. It is associated with fewer gastrointestinal adverse events while having a good therapeutic effect. We present three patients effectively treated with acemethacin without adverse events of the gastrointestinal tract.

[Headache induced by oral intake of metoprolol in a patient with chronic and limited cardiac tamponade]. / Ból glowy indukowany doustnym przyjmowaniem metoprololu u pacjenta z przewlekla, ograniczona tamponada serca.

The papers describing the secondary headache attributed simultaneously to vascular disorder beyond the head and neck and use of drug are lacking. There is no adequate position for that type of headache in the current classification of headache, either. The case of secondary headache induced by metoprolol in a 57-year-old patient with superior vena cava syndrome (SVCS) is reported. He suffered from chronic paroxysmal headache with accompanying rash and the superficial jugular veins were over-flown about 30 minutes after an intake of 25 mg of metoprolol. At the seventh day of hospital stay, the sudden death occurred. Postmortem examination showed the limited cardiac tamponade caused by aortal perforation and adhesive pericarditis SVCS produced by chronic, limited cardiac tamponade revealed after oral intake of metoprolol can be the cause of secondary headache that might be defined as "headache attributed to vascular disorder beyond the head and neck and related to medication for other indications".

[Cauda equina syndrome caused by Tarlov's cysts--case report]. / Zespól ogona konskiego na podlozu mnogich torbieli Tarlova--opis przypadku.

UNLABELLED: Perineural Tarlov cysts located on lumbo-sacral roots can be a cause of cauda equina syndrome. OBJECTIVES: 1) To draw attention to the fact that multiple Tarlov lumbo-sacral perineural cysts can produce serious movement disturbances. 2) To document the usefulness of the magnetic resonance imaging in noninvasive diagnosis of perineural cysts. CASE DESCRIPTION: A male patient, 80 years of age, suffered from progressive weakness of lower limbs, which caused an increasing drop of the feet. The disease began in August 2000, following a long journey by train. The patient additionally complained of urinary incontinence as result of sneezing, coughing or fast walking. The urologist did not find prostatic gland hypertrophy. An examination by the internist revealed atheromatous myocardiopathy in circulation failure stage. Magnetic resonance imaging showed multiple perineural cysts up to 15 mm in diameter on lumbo-sacral roots. This clinical picture, supported by the magnetic resonance imaging allowed to recognize cauda equina syndrome caused by Tarlov lumbo-sacral perineural cysts. DISCUSSION: This case is a reminder, that part of perineural cysts, particularly multiple, can be a cause of nerve roots injury, and their lumbo-sacral location can produce cauda equina syndrome. As reported by Zarski and Leo, Tarlov cysts were cause of 7.3% of pain syndrome cases 2 patients in the study group showed lower limb claudication. Magnetic resonance imaging of patients with back pain, performed by Paulsen, Call and Murtagh, revealed that Tarlov cysts occurred in 4.6% of patients, but only 1% had the symptoms connected with the presence of those cysts. In available Polish literature no report has been found referring to fixed cauda equina syndrome which was caused by multiple cysts revealed through the magnetic resonance imaging of spinal canal. Only Zarski and Leo, discussing the correlation between the clinical and radicographic picture, described transient cauda equina syndrome in two patients who, beside Tarlov cysts, were also found to have intervertebral lumbosacral disc herniation. Tarlov was the first to describe well documented cauda equina syndromes caused by cysts on the lumbo-sacral roots. It is necessary to emphasize the established role of magnetic resonance of spinal canal in the diagnosis of perineural cysts on the lumbo-sacral roots as well as other anatomical anomalies of cerebrospinal fluid spaces. Despite the fact that cauda equina syndrome in the case reported here was a serious complication of multiple Tarlov cysts in the lumbo-sacral region, a surgical treatment was not undertaken; in such cases this treatment should be the chosen procedure. CONCLUSION: Multiple perineural Tarlov cysts in lumbo-sacral region, without disc herniation or other cause of vertebral canal stenosis, can produce cauda equina syndrome.